Provider Demographics
NPI:1356548499
Name:MACSHEA, AMENA (LCMHC)
Entity type:Individual
Prefix:MS
First Name:AMENA
Middle Name:
Last Name:MACSHEA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:HARTLAND FOUR CORNERS
Mailing Address - State:VT
Mailing Address - Zip Code:05049-0074
Mailing Address - Country:US
Mailing Address - Phone:802-436-2133
Mailing Address - Fax:802-436-1733
Practice Address - Street 1:77 DENSMORE HILL
Practice Address - Street 2:
Practice Address - City:HARTLAND FOUR CORNERS
Practice Address - State:VT
Practice Address - Zip Code:05049
Practice Address - Country:US
Practice Address - Phone:802-436-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT11514819OtherCAQH PROVIDER ID